Prevalence of metabolic syndrome among adolescents in India: a population-based study

Determinants of childhood and adolescent obesity and it's effect on metabolism in South Indian population

OBJECTIVES

The primary objective is to determine the risk factors underlying the development of childhood and adolescent obesity. The secondary objective is to determine the predictors of metabolic syndrome (MetS) in childhood and adolescent obesity and its metabolic alterations in the South Indian population.

METHODS

This is a cross-sectional study conducted over two years. We have screened 3,195 school children and adolescents from lower and lower-middle socioeconomic groups. From this pool, by random cluster sampling technique, we have included 166 overweight and obese individuals and 38 control subjects. We have analyzed their sociodemographic, dietary, lifestyle, anthropometric, clinical, and metabolic parameters.

RESULTS

The prevalence of overweight and obesity in rural areas was 14.2 and 7.6 %, respectively, and in urban areas, it was 16.1 and 8.8 %, respectively. The age distribution of the control and study group is 12.3 ± 1.5 and 13.0 ± 1.9 years with a male-to-female ratio of 1.4:1 and 1.6:1, respectively. Our study found a higher average consumption of energy-dense food and screen time in the obese group compared to the control group. The average outdoor play time was 1.5 h per day in the control group and less than 0.5 h per day in the obese group. In our study, the waist-to-height ratio (WHtR) optimum cutoff value of 0.56, has 95 % sensitivity and 84 % specificity, effectively identifying MetS cases. HOMA-IR optimum cutoff value of 2.25, has 96 % sensitivity and 72 % specificity. The triglyceride-glucose index (TGI) optimum cutoff value of 4.51, has 92 % sensitivity and 88 % specificity indicating a strong balance between correctly identifying positive and negative MetS cases.

CONCLUSIONS

Our study found that even in lower socioeconomic status, there is a higher prevalence of childhood and adolescent obesity due to an urbanized lifestyle in rural areas, a sedentary lifestyle, higher consumption of low-cost energy-dense foods, and higher screening time in this electronic era. We also conclude that WHtR is a simple anthropometric marker that predicts MetS more effectively than BMI and WHR among children and adolescents. HOMA-IR and TGI are effective biochemical markers to identify metabolically unhealthy obesity early.

Cardio-metabolic traits and its socioeconomic differentials among school children including metabolically obese normal weight phenotypes in India: A post-COVID baseline characteristics of LEAP-C cohort

BACKGROUND

Cardio-metabolic risks emerge in early life and progress further in adult life. In recent times, COVID-19 pandemic aggravated risks owing to poor food security and diet quality. We aimed to assess the prevalence of cardiometabolic traits including the metabolically obese normal weight phenotype and its socioeconomic differentials in children and adolescents aged 6-19 years in India.

METHODS

A baseline assessment was conducted between August and December, 2022, as part of a school-based cohort study that aimed at longitudinally evaluating the anthropometric and metabolic parameters among urban children and adolescents aged 6-19 years from three public (non-fee paying) and two private (fee paying) schools in India. Private and public schools were considered as a proxy for higher and lower socioeconomic status respectively. Blood pressure and blood samples in a fasting state were obtained only from adolescents aged 10-19 years. The prevalence and its 95% confidence interval using the Clopper exact method and adjusted prevalence ratios were calculated using random-effects logistic regression models.

FINDINGS

Among 3888 recruited students, 1985 (51.05%) were from public schools, and 1903 (48.95%) were from private schools aged 6-19 years. The overall prevalence of underweight was 4.95% (95% CI 4.29-5.69), with a significantly higher prevalence in public schools (8.09%) than private schools (1.69%). The overall prevalences of general obesity and central obesity were 13.41% (95% CI 12.35-14.52) and 9.15% (95% CI 8.26-10.11), respectively, with significantly higher prevalence in private schools (p < 0.001). The prevalences of general and central obesity were four times (adjusted PR = 4.42, 95% CI 2.90-6.72) and eight times (adjusted PR = 8.31, 95% CI 4.82-14.35) higher, respectively, in private schools than public schools. The overall prevalence of hypertension was 7.37% (95% CI 6.33-8.51), and similar prevalences were found in public and private schools. Private school students had 2.37 times higher prevalence of impaired fasting plasma glucose (adjusted PR = 2.37, 95% CI 1.19-4.72) and 3.51 times higher prevalence of metabolic syndrome (adjusted PR = 3.51, 95% CI 1.54-8.01) than public school students. Among 2160 adolescents, 67.73% (1463) had normal body mass index. The prevalence of metabolically obese normal weight phenotype (MONW) was 42.86% (95% CI 40.30-45.44), which is higher in public [46.39% (95% CI 43.25-49.54)] than private [35.33% (95% CI 30.99-39.86)] schools (p < 0.001) with adjusted PR of 0.91 (95% CI 0.70-1.17). The most prevalent cardio-metabolic abnormality among metabolically obese normal weight phenotype was low high-density lipoprotein-c, significantly higher among adolescents from public schools (62.12% vs 52.73%, p = 0.039) than private schools. The prevalence of metabolically obese underweight (MOUW) (48/115) was 41.74% (95% CI 32.61-51.30), being higher among adolescents in public schools than private schools but not significant (p = 0.264).

INTERPRETATION

Effective implementation of food security measures and targeted initiatives will be crucial to mitigate the socioeconomic disparities associated with the growing burden of cardiometabolic traits. Metabolic obesity among phenotypically normal or underweight adolescents should not be overlooked but should be intervened early through novel screening criteria to prevent future cardiovascular burdens. These findings also have implications for low- and -middle income countries like India, which are undergoing a nutritional transition where socioeconomic status strongly influences cardio-metabolic traits.

Unraveling Metabolic Syndrome in Youth: The Obesity Epidemic's Hidden Complication

BACKGROUND/OBJECTIVES

One of the metabolic complications of obesity is known as Metabolic Syndrome (MetS). This narrative review aims to synthesize current research on MetS in young populations, identify knowledge gaps, and guide future studies and funding priorities. It provides evidence-based insights into screening, diagnosis, and treatment, offering practical guidance for healthcare professionals.

METHODS

A comprehensive search of the literature was conducted to identify relevant studies on obesity in MetS in PubMed and Google Academic electronic database. The search was performed using a combination of "obesity", "complications", "metabolic syndrome", "children", and "adolescents" keywords. Studies were selected based on predefined inclusion and exclusion criteria to ensure relevance and methodological rigor.

RESULTS

The lack of universally accepted diagnostic criteria for MetS in children has led to inconsistencies in its definition across medical literature. Irrespective of the chosen diagnostic approach, the prevalence of MetS in children and adolescents has exhibited a concurrent rise with the increasing rates of obesity in this age group. The pathophysiology of MetS remains incompletely understood, with ongoing discussions on the interplay of genetic, epigenetic, environmental, dietary, and lifestyle factors. Screening for MetS is recommended for overweight and obese children.

CONCLUSIONS

Establishing global, consensus-driven criteria that account for ethnicity, gender, and age would enhance diagnostic accuracy and treatment approaches. The prevention of excessive weight among children and adolescents stands as a paramount objective within modern society's healthcare system. Considering the complexity of the disease and the treatment, the team must be multidisciplinary.

Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India

BACKGROUND

Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India.

METHODS

This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels.

RESULTS

Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40 y) but not sex.

CONCLUSIONS

A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40 y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.

Prevalence of Metabolic Syndrome and Its Associated Risk Factors Among Schoolchildren Aged 11-13 Years Living in Thiruvananthapuram District, Kerala, India: A Nested Case-Control Study

INTRODUCTION

Metabolic syndrome is a cluster of conditions that includes increased blood pressure, increased blood sugar, excess body fat around the waist, and a rise in triglyceride levels which could increase the risk of developing type 2 diabetes and cardiovascular diseases. While metabolic syndrome is typically associated with adults, concern is growing about its prevalence and implications among children and adolescents. The rapid rise in childhood obesity and physical inactivity has led to an increase in risk factors among young populations, making it a pressing public health issue. This study aims to investigate the risk of metabolic syndrome among children aged 11-13 years, exploring its association with various sociodemographic and clinical factors.

METHODS

A nested case-control study was conducted from June 2021 to November 2021 among a cohort of school children aged 11-13 years in Thiruvananthapuram district, Kerala, India. Twenty-two clusters (schools) were identified from the schools in Thiruvananthapuram's educational subdistrict using populations proportionate to size. Data on the sociodemographic characteristics and lifestyle practices of 1,580 schoolchildren and their parents were collected using a questionnaire. Body mass index, waist circumference, and blood pressure were also assessed to screen children for metabolic syndrome. Fasting blood glucose, triglycerides, and high‑density lipoprotein levels were evaluated in 57 cases (children with metabolic syndrome after screening) and 116 controls (children without metabolic syndrome after screening).

RESULTS

The prevalence of pediatric metabolic syndrome as defined by the International Diabetes Federation (IDF) classification in the sample was 3.6% (n=57) (95%CI 1.6-6.6). Modifiable and nonmodifiable risk factors found to be associated with pediatric metabolic syndrome after multivariate analysis were gender, decreased physical activity, especially organized physical activity and moderately vigorous physical activity or play, skipping meals, sleeping for less than eight hours at night, eating with screens on, use of screens for more than two hours daily, and preference for soft drinks or carbonated drinks over water when thirsty. This study also evaluated the predictive power of the associated factors for pediatric metabolic syndrome using receiver operating characteristic (ROC) analysis. The ROC curve showed an area under the curve of 0.926 (95% CI: 0.891-0.961, p < 0.001), indicating high predictive power.

CONCLUSION

The findings of this study brought out evidence of an escalation in the rate of metabolic syndrome among children in their early adolescent stage. This rise is a trend with increasing sedentary time and the overuse of screens by the younger generation in this modern era of gadgets and technologies. Our findings would act as a catalyst in implementing community and school-based activities to improve physical activities and lifestyle modifications among children, thereby reducing the risk of early development of metabolic syndrome.

Prevalence and influencing factors of metabolic syndrome among rural adult population in a district of South India

Background

Metabolic syndrome has increased globally due to sedentary lifestyles, unhealthy diets and obesity, which is posing a substantial burden on healthcare systems. Understanding the determinants of metabolic syndrome like lifestyle factors, socioeconomic status and the environment are vital for devising effective prevention and management. Research into these determinants helps to identify high-risk populations and develop interventions to reduce its occurrence.

Objectives

i. To estimate the prevalence of metabolic syndrome among the adult population. ii. To determine the factors associated with metabolic syndrome among the adult population.

Methodology

A cross-sectional study was carried out among 410 adults (≥18 years). A semi-structured questionnaire was used to collect data and National Cholesterol Education Program's Adult Treatment Panel III criteria was used to diagnose metabolic syndrome. Continuous and categorical data were represented as mean and proportion, respectively. The strength of the association was determined using the prevalence ratio and adjusted prevalence ratio.

Results

The mean age of the participants was 44.97 ± 14.7, about 58.3% of them were females. Metabolic syndrome prevalence was 39.8%. Multivariate regression analysis demonstrated that being over 40 years old, marital status, higher socioeconomic status, skilled workers, physical inactivity and obesity were independently linked to metabolic syndrome.

Conclusions

The burden can be reduced by identifying the risk factors at the early stage through screening and by adopting a healthy lifestyle.

Abnormal Body Composition Increases the Cardiometabolic Risk in Adolescents and Young Adults With Turner Syndrome

OBJECTIVE

To determine the cardiometabolic risk of adolescents and adults with Turner syndrome (TS) and whether and how anthropometry and body composition predict this risk.

METHODS

We compared the anthropometric, biochemical, and dual-energy x-ray absorptiometry-derived body composition parameters of 103 girls and women with TS aged 12 to 30 years and 103 controls of the same age and body mass index: (1) between TS with and without metabolic syndrome (MetS), (2) between the different karyotypes of TS, and (3) between growth hormone recipients and nonrecipients.

RESULTS

Individuals with TS had higher prevalence rates of truncal obesity (57.2%), MetS (37.9%), prediabetes (20.4%), dyslipidemia (73.8%), hypertension (9.7%), and hepatic steatosis (15.5%) and a greater total body fat percentage (38.43% vs 34.26%) and fat mass index (9.15 vs 6.71 kg/m2) but a lower lean mass index (11.05 vs 12.49 kg/m2) than controls (P <.001). Individuals with TS and MetS (n = 39) had a higher total body fat percentage (41.74% vs 36.42%, P <.0001), truncal fat percentage (44.66% vs 36.09%, P <.0001), and visceral adipose tissue mass (495.57 vs 276 g, P <.0001) than those with TS but without MetS. Those with classic TS (45,X) had a higher prevalence of prediabetes (32.6% vs 10.5%, P =.01). Growth hormone recipients had a lower prevalence of MetS and lesser truncal obesity. Altered body composition was significantly correlated with metabolic risk. The truncal fat percentage independently predicted MetS (odds ratio, 1.12; 95% confidence interval, 1.003-1.24; P =.04). Waist circumference and waist-hip ratio predicted metabolic risk with good sensitivity and specificity.

CONCLUSION

Adverse cardiometabolic risk and altered body composition start early in life in TS. Postpubertal women with TS should be routinely assessed for truncal obesity, dysglycemia, dyslipidemia, and liver steatosis, irrespective of body mass index and karyotype.

Prevalence of metabolic disorders among women in reproductive age group in hilly rural area of North India

Background

Metabolic syndrome consists of cardiometabolic risk factors that promote the development of atherosclerotic cardiovascular disease, type 2 'DM' and obesity. These are associated with increased cardiovascular mortality and morbidity. Metabolic disorders (MD) are becoming more prevalent both in developing countries and developed countries and are now considered as lifestyle diseases. In women of reproductive age group, especially pregnancy, the blood glucose level is increasing which adversely affects the health of mother and child. Similarly, high blood pressure also precipitates the problems. This study was carried out to find the prevalence of hypertension, diabetes mellitus, obesity and 'MD' among the women living in remote rural set-up.

Materials and Methods

This cross-sectional study was done among women of reproductive age group in 15 villages from 5 panchayats of field practice area of Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan. They were screened for 'MD' through investigative procedures (weight, height, BMR, abdominal girth, blood pressure through sphygmomanometer, blood glucose through the glucometer method), serum HDL and triglycerides. Respondents from the family were asked about the common/general information of house. The tool used for collecting general and relevant information from the respondent was a questionnaire, which was pretested for validity before being used in the field.

Results

Four-hundred and sixty-seven women of reproductive age group participated in the study. Half of the participants were with qualification of matriculate and 9.2% participants were illiterate. Three-fourths of the participants were married women and 89% were vegetarian. Sixty-four per cent of participants were housewives. Half of the participants had a normal BMI, whereas 28.9% were overweight and 10% were obese. The prevalence of hypertension and diabetes among the participants were 12.5% and 9.8%, respectively. Forty-seven per cent participants had a waist circumference above 80 cm.

Conclusion

The level of non-communicable diseases is related with the MD which has the adverse effect on the various systems and organs of the subjects. The MD can be controlled with the certain changes in the life style pattern. The GOI is also concerned with such scenarios in the country. It is recommended that women of reproductive age group undergo regular blood pressure and blood sugar screenings to detect hypertension and diabetes early and take appropriate measures to manage them.